Turning AMR words into action

It was Antibiotic Awareness Week earlier this month, and, as Chair of the UK government’s Review on Antimicrobial Resistance (AMR) under Prime Minister David Cameron, I participated in a number of events to draw attention to this important public-health issue.

The Review showed that even as the world runs out of effective antibiotics, we are overusing those that still work. If we do not rein in these excesses and develop new effective drugs quickly, there could be ten million people dying from AMR-related illnesses every year by 2050 – up from 700,000 today. The total cost to global GDP between now and then will have been $100 trln.

At the Science Museum in London, I spoke ahead of the launch of the new exhibition “Superbugs: The Fight for our Lives,” which will last for the next 15 months. The exhibition is a good example of the increased attention AMR is receiving. The organisers expect around 1.5 million people to see it, but I challenged them to aim for six million – about 10% of the United Kingdom’s population.

One way to do that would be to take the exhibition on the road, first to somewhere like Manchester, but eventually to more farflung locations such as Beijing and Delhi. If you are reading this and you are a pharmaceutical executive, this is your cue to help out. One modest way for the pharmaceutical industry to address the AMR threat is to sponsor such exhibitions, so that more people have a clear, scientific understanding of the issue.

In the Review’s final recommendations, increasing public awareness was one of our Ten Commandments. Despite the progress that has been made, much more could be done. For example, one of three large drug makers I met with recently appears to have good relations with China, whose 1.3 billion people have a crucial role to play in the fight against AMR. So, I suggested that the company try to work with the Chinese messaging service WeChat to develop an AMR-awareness app.

Among the other Ten Commandments on which some progress has been made, I am particularly excited about three. First, a promising amount of money is flowing into early-stage research and development, owing to a number of initiatives from Germany, the UK, the United States, the European Investment Bank, and the Wellcome Trust (which financed the Review).

Second, more researchers seem to be focusing on AMR (although I base that conclusion purely on the frequency and geographical locations of the speaking invitations I receive). And, third, the misuse of antibiotics in agriculture has been reduced more than I would have expected, owing to voluntary efforts by leading food producers and supermarkets. Far more needs to be done, but this is a good start.

In the past 18 months, international coordination in the fight against AMR has also i mproved, with the past two G20 summits and a High-Level United Nations meeting all shining a spotlight on the issue. Still, world leaders’ statements will turn out to be meaningless if not backed up with action.

Unfortunately, action has been lacking in the development of new diagnostics, vaccines (and vaccine alternatives), and antibiotics. Since the Review published its final report, there has been a lot of talk about these three crucial recommendations, particularly from the pharmaceutical industry. At the World Economic Forum’s annual meeting in January 2016, the industry supported a generalised commitment to new initiatives – which one could interpret as a request for more government funding. And during Antibiotic Awareness Week, pharmaceutical executives presumably met to discuss AMR.

And yet no concrete action has been taken. To change that, the top 20 antibiotics producers could ask their respective governments to “pilot” a funding mechanism for taking new drugs through clinical trials and to market. In the Review, we recommended market-entry rewards for makers of new drugs, provided that the lump sum is not used for marketing and promotion. From what I gather, that proposal has been well received.

One of the pharmaceutical companies I met with recently showed me evidence that the use of antibiotics in treating young children in Iceland has plummeted since 2011, owing to vaccinations against pneumococcal infections. This was pleasing to see. As the Review showed, one of the best ways to prevent the overuse of antibiotics is to prevent infections in the first place.

Here is a final idea for the top 20 pharmaceutical firms to consider. Why not contribute $1 bln each over the next decade? The $20 bln prize could be divided among the companies that first produce appropriate new diagnostic technologies, vaccines, or antibiotics to address the World Health Organisation’s 12 “priority pathogens.”

Obviously, this proposal is rather unconventional. But for one of the most profitable sectors of the world economy, $20 bln spread over ten years is almost peanuts. Collectively, the top 20 drug makers’ annual revenues are around $600 bln, and their annual profits are somewhere between $150200 bln. An annual contribution of $2 bln would be less than 0.33% of combined annual revenues, and less than 2% of annual profits. Moreover, it would be an investment in three of the Review’s Ten Commandments. And in a world demanding more corporate social responsibility, it might even give pharmaceutical companies’ share prices a healthy boost.